Critical Pulse

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Exclusively for SCCM Select and Professional members, Critical Pulse contains late-breaking and important information to help your practice.

Triglyceride-Glucose Index Correlates With the Incidence and Prognosis of Cardiac Arrest Following Acute MI

A multicenter retrospective study in Cardiovascular Diabetology aimed to clarify the link between the triglyceride-glucose index (TyG) and incidence and prognosis of cardiac arrest (CA) following acute MI (AMI). A total of 5208 patients diagnosed with AMI, of whom 371 developed CA, were included in the study. Higher TyG levels were observed in AMI patients with CA than in those without (9.2 [8.7-9.7] vs. 9.0 [8.5-9.4]). TyG was also a significant risk indicator for both in-hospital (OR = 1.711) and ICU mortalities (OR = 1.520) in AMI-CA patients and was associated with prolonged lengths of stay.

Low Total Lung Capacity May Increase Risk of Mortality in Patients With Restrictive Pulmonary Disorders

A systematic review and meta-analysis in BMC Pulmonary Medicine investigated the relationship between changes in total lung capacity (TLC) and the risk of mortality in patients with restrictive pulmonary disorders. A total of 26 studies were included in the meta-analysis, comprising 4460 subjects with relatively low TLC and 12,119 subjects with high TLC. Reduced TLC was associated with increased risk of all-cause mortality (adjusted hazard ratio 1.70; 95% CI, 1.31-2.20). The estimated risk ratio from the studies that reported both the number of participants and deaths was 2.01 (95% CI, 1.56-2.60). The findings were primarily based on observational studies, which carry low to moderate certainty.

Ultrasound-Guided Fluid Management Improves Outcomes in Patients With Septic Shock

A randomized controlled trial in Journal of Trauma Nursing evaluated the use of critical care ultrasound for individualized volume management in patients with septic shock. A total of 113 patients with septic shock were randomly allocated into study (n = 57) and control (n = 56) groups. On ICU admission, the patients were resuscitated according to the latest sepsis and septic shock guidelines and early goal-directed therapy. The study group additionally underwent critical care ultrasound examination to monitor and guide the adjustment of fluid resuscitation in real time. The study group’s blood lactate was significantly lower, and lactate clearance was significantly higher than the control group (P < .05). The incidence of pulmonary edema, incidence of left heart failure, SOFA score, and length of ICU stay in the study group were also significantly lower than in the control group (P < .05). Critical care ultrasound improved outcomes and helped guide management of patients with septic shock.

Alterations in Lipid Profile Are Associated With Poor Outcomes in Critically Ill Children

A secondary analysis of a randomized controlled trial in Critical Care (London, England) evaluated whether alterations in the lipid profile of critically ill children are associated with poor outcomes. The study included 96 critically ill children staying ≥ 5 days in the PICU and 1165 children with available admission plasma samples. Plasma HDL cholesterol, LDL cholesterol, total cholesterol, and triglycerides were low throughout the 5 PICU days, with only HDL cholesterol further decreasing over time (P < 0.0001). Lower admission HDL and total cholesterol concentrations were independently associated with a lower likelihood of an earlier live PICU discharge (P < 0.001) and with a higher risk of 90-day mortality (P ≤ 0.01). Higher plasma triglycerides were independently associated with higher risk of 90-day mortality (P = 0.004). Low admission plasma HDL cholesterol was independently associated with a higher risk of acquiring a new infection (P = 0.05). Causal associations will require further research.

Gene-Expression Diagnostics Can Identify Risk of Poor Outcomes in Patients with Sepsis

An observational study in Critical Care (London, England) aimed to identify subgroups of septic patients at high risk of poor outcome using a rapid, multiplex RNA-based test. The study included 357 patients with sepsis. Patients were assigned into high and low risk groups using 2 different models previously developed for the Immune-Profiling Panel prototype on the bioMérieux FilmArray system. For model 1, 90-day mortality was higher in the high-risk group at each of 3 sampling times (S1: 35% vs. 24%, P = 0.04; S2: 43% vs. 20%, P < 0.001; S3: 52% vs. 24%, P = 0.007). For model 2, mortality was significantly different only at the second sampling time (S1: 30% vs. 27%, P = 0.77; S2: 34% vs. 14%, P = 0.002; S3: 35% vs. 23%, P = 0.13).

Haloperidol Reduces Length of ICU Stay but Not Delirium in ICU Patients

A systematic review and meta-analysis in European Journal of Medical Research investigated the efficacy of haloperidol for the treatment of ICU adult patients with delirium. A total of 2863 patients were included in the analysis. There was no difference in short-term (28-30 days) mortality between the haloperidol and control groups (OR 0.89; 95% CI, 0.60-1.32, P = 0.56) and long-term (90 days – 1 year) mortality (OR 0.87; 95% CI, 0.70-1.07, P = 0.19). The haloperidol group demonstrated a reduction in length of ICU stay (mean difference –1.13; 95% CI, –1.93 to –0.32, P < 0.05) compared to the placebo group, with no statistically significant difference in length of hospital stay (mean difference –0.24; 95% CI, –1.71 to 1.24, P = 0.75).

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